The Twists and Turns of Type 1 Diabetes - Where Do We Start?

If only there was a complete list of Do's and Dont's but unfortunately Type 1 Diabetes is not like that. It's not as simple as taking a paracetamol for a headache, sticking a plaster on a wound, drinking plenty of water before going to bed to avoid a hangover.

In fact although we all have our regime, "the Holy Grail of life as we must live it with type 1 diabetes" doesn't really exist.Yes we have our ratios, and our DAFNE type courses, but there are just so very many variables, absolutely everything we do, and everything we eat impacts on our blood glucose in different ways, all effecting our blood glucose readings at various times of the day and night and for various reasons.

I'm going to attempt to highlight some of these, but only as a type 1 diabetic, I'm not a professional. Please discuss any of the content in this blog with your diabetes team, and seek their advice in relation to your own type 1 management. This is just a guide to questions you'll need to ask.

First let me say other than not producing our own insulin causing us to be type 1 diabetics, our diabetes basically leaves us with an intolerance to carbohydrates, which by the way is sugar in another form. Most foods have carbohydrate ( carbs ) so not only do i consider the food I'm eating when I'm calculating my insulin dose for that food, I'm also considering what form that food is in. (whole, mashed, pulped, cooked etc ) because yes this makes a difference. Il also take into account what my blood glucose reading is at the time, whether I'm going for a walk soon, going to do a lot of housework, whether or not I'm sick, is the weather very hot or very cold, so it's not just eat and apple and inject xx amount of insulin. It's really about understanding your food, not just knowing it.

The all important carb counting :

We all have an insulin to carb ratio.That's the amount of insulin we take per gram of carbohydrate (carb) we have our correction ratio,
(a means of using our insulin to correct a blood glucose that's higher than our recommended guidelines) and our sick day plan (a plan to manage our blood glucose and insulin while enduring a vomiting bug or other illness. NO you don't stop injecting if your vomiting and not keeping food down) Your sick day plan is a special set of instruction given to you by our Diabetes team. If your not clear about yours then ask them for it. Its a very specific set of rules to be followed. Children, pumpers and people on multiple daily injections ( MDI ) may all have different instruction of what to do in this situation.

A food / carb EXAMPLE ONLY :

Bread roll 30 gms carbs

Insulin - carb ratio 5/1 ( that's 5gms carbs to 1 unit of insulin )

That big bread roll would mean 6 units of insulin in this example 
( 30 divided by 5 = 6 ) 

Simple Ye ?

Now let me bring you further on this journey......

Slap a thick couple of slices of my favorite cheese in that bread roll. Even toast it or melt it if you like. 

The cheese has no carbs, so it's still only 30gms carbs for what's now a delicious cheesy bread roll, however things have changed a bit now. 
But why?

My cheese has a high fat content, fat slows down the impact the carb in the bread roll has on my blood glucose (BG) I may find if i inject just as i start to eat, that after my insulin ( fast acting / bolus ) has peeked and is now becoming a distant memory that my blood glucose is still rising​! I haven't reached the magic 2 and a 1/2 hour period (insulin peek time) 
since i last injected, so 

I​ 

can't really safely inject again just yet, but still the BG numbers climb higher. So what could 

I​ 

have done differently?

Split the insulin dose ......

Using the same delicious cheesy bread roll example 30 gms carbs / 6 units of insulin.

​Il take ​3 units as I ​start eating and 3 units when iv finished. Giving the effect of the insulin longer to work. In other words it will be longer before my much needed insulin peeks and then starts to dwindle away, giving the insulin iv injected a longer period to work or lengthening its effect. (Seek advice from your diabetes team about this)

​​

Now to a sample list of foods that have this effect : 

• Pitza.
• Garlic bread.
• Chinese takeaway.
• Battered foods that are deep fried.
• Chips,
• Pasta ( in some people ).
• Ice cream.
• Milk Chocolate.
• White chocolate.
• Cakes with a butter icing or frosting

There will be other foods you'll come across that have a high fat content, these are just the ones I can think of. Everyone's diet is different.

Fruits Vs smoothies & juiced fruit :

Let's take some fruits as an example : 

1 orange 7gms carbs

1 Apple 20 gms carbs

2 pineapple rings 8gms carbs 

All containing fibre when eaten whole and much needed nutrients, the fibre content will slow down the impact of the sugar that the fruit contains, if I​ inject as instructed then im​ sorted.

Now pulp, mash, liquidise those same fruits, 

​Iv​ taken out the fibre, Iv​ still got the nutrients, but because of the lack of fibre ​Iv​ now got high speed sugar, coursing through my veins before 

​my​ insulin gets a chance to cop on.

Potatoes, 

• Eaten whole, are high fibre and impact our BG, on a sort of normal time frame.
• Eaten mashed they become a quicker carb hit, rising ​my​ BG faster than the whole potato.
• Eaten fried / chipped become high fat, impacting my​ BG a lot slower than the whole potato.

Basically ​im​ eating the same potato, so the same carbs, but in different forms, all having a different impact on your blood glucose, over different time fames.

Ice cream. 

Now this I can eat with out any rise in BG, and without insulin, BUT 2-3 hours later my BG will start a steady climb because of the fat content.

Chocolate. 

Ah yes chocolate. Now and then at 8pm watching the soaps. Now here's a real sneaky one, choose the bar. Inject the insulin dose, eat the chocolate. Delicious ...... And everything seems to be going to plan. 

2am and your awake to use the loo, you'v maybe got a headache and you test your BG. It's in the teens and I​ was 8ish going to bed, I would​
be fairly safe to blame the chocolate this time, it's because of the high fat content.

Infection / Illness / stress

Sometimes when Iv​ got an unusually high BG with nothing obvious to blame, it could be my​ first warning to an infection, a 24 hour bug, or an oncoming illness of some kind.Stress because of work, exams or just everyday life stresses.

Treatments

Even a dental local anesthetic can effect my​ BG. To either rise it or more usually drop it.I ​need to allow for this one when undergoing treatment. The dentist is guided by the diabetic, they rightly presume you know your stuff, so please​.......​ know your stuff !

Heat and Cold weather

Yes the weather eff​ect'​s my BG, but people react differently to this one. I would run low in the heat having to keep an extra vigilant eye on my BG in case of hypos.

I would run high in the cold weather, needing a little extra insulin to meet my chosen target.

Exercise

Remember when you exercise you burn off sugar first, to continue that exercise you need to compensate by replacing that sugar, which is why type 1, exercising and weight loss  can be a fruitless challenge. Special care and training is needed for marathons etc.

Hoovering, window cleaning, children running around playing all qualify as exercise.

Foot tips

Check feet daily for blisters, cuts etc daily,  keep feet clean and dry. Never moisturise between the toes. Wear socks inside out to avoid the seam rubbing the toes. (a chiropodist who is also a type 1 told me this) 

​I ​Wear 2 pairs of socks in my trainers to reduce the risk of blistering. If you notice cracks, cuts, blisters or anything else unusual seek medical advice and don't be tempted to stick on a plaster and ignore it.Take professional advice on nail cutting and removing hard skin.

Skin

Skin problems and slow healing is quite common in people with diabetes of any type.

Alcohol

Now here's a tricky one, yes there's carbs in alcohol, but we don't count them, why ? Because the day after drinking, the alcohol can drop your BG and leave you prone to hypos. It's advisable to eat a carb before going to bed after drinking alcohol. 3 alcohol free days a week is what I was advised on diagnosis and iv stuck to it.

Coffee

Now here's a dark horse if ever I found one, I get up in the morning, With a BG of maybe 5-6, I have a coffee, just a regular black instant coffee, with a small drop of low fat milk. (no insulin I hear you say) well you'd be wrong. Coffee acts like speed, stimulating the body, or more precisely the liver. 

Just over a 1/2 hour after drinking my morning fix I'd have a BG of at least 9-10 if I'm lucky (that's without injecting insulin) so my morning cuppa is always accompanied by a little insulin unless of course I start off low. If your a coffee drinker you may know what I mean.

Hormones

Hormones Of the general teenage, menopause, puberty, post natal varieties can all effect your BG. So either speak to your diabetes team or T1 people experienced in this area. I'm also pretty sure pregnancy and childbirth take their toll but likewise speak to someone who knows about these things.

Lack of sleep, trauma, worry, exhaustion the list of what effects a diabetic, ( particularly a type 1 ) is endless. Basically every part of our lives and our very being, whether it be emotionally or physically has an impact on how your body copes, therefore can have an effect on your blood glucose.

Treating Hypos - lows - hypoglycemia

We all have our favorite hypo treatment, yes you heard me our favorite treatment. Lucazade is not your only option. This is my big chance to have something I wouldn't normally get to eat, so for me it's jelly beans or jelly babies. Some use fruit juice, full sugar soda, or glucose tablets there are no hard and fast rules to which high sugar treatment you prefer to use to get those blood glucose numbers back up fast. Your diabetes team will advice you about how much of your chosen hypo fix to take, or check out the carbs and cals app or book.

WE DONT TREAT A HYPO WITH CHOCOLATE BECAUSE IT WONT IMPACT ON YOUR BLOOD GLUCOSE FAST ENOUGH TO FIX IT 

( REMEMBER CHOCOLATE IS HIGH FAT ) & TREATING LOWS NEEDS HIGH SUGAR.

Finally.

It was my Diabetes Team who said NEVER go to bed with a BG below 8, and that's something iv never forgotten and stick with to this day. 

After doing research of my own I started a lower carb diet than the diet I was previously on, substituting some of my foods for a lower carb alternative. I did this to reduce the weight I'd gained after diagnosis, to gain a tighter more manageable control, and to reduce my HBA1C.

I achieved these things and have chosen to continue with this lifestyle, feeling generally healthier with more energy.

Write out your questions so you won't forget them. Bring them to you next diabetes clinic and discuss and question those things you may not understand right now. Education and learning is the key to living at ease with your Type 1 Diabetes. 

Lack of knowledge NEVER EVER takes away the facts, the risks, or the disease.

EVERY DIABETIC IS DIFFERENT SO WHAT WORKS FOR ME OR YOU MAY NOT WORK FOR OTHERS.

SEEK - QUESTION - IMPROVE are 3 very important words when you have any type of diabetes.

• SEEK : More information than you may already have, and support from others living with type 1.
• QUESTION : Everything you don't understand.
• IMPROVE : Your knowledge, your management and your understanding of type 1 diabetes in order to improve your life.

Davina 

A Type 1 Diabetic 

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The #Type1Diabetes See-Saw, All we need to get High is Healthy Food !

The Type 1 Diabetes See-Saw, All we need to get High is Healthy Food !

#Type1Diabetics can get #High without #Drugs.

Iv wanted to put this into words for quite a while now in the hope that others might just understand a bit more, but we are all so very different.

Our routines, our ratios, our insulin type, some people pump, some on insulin pens, then there are others mixing insulin and using a syringe.

For blood glucose monitoring & testing there are people using, a The Dexcom, The Libra, The Guardian and various other types and makes of blood glucose meters. Apple are even going to get into this apparently, it seems nowadays Blood Glucose Testing is #trending but it makes a change from "Cinnamon & other stuff curing us & reversing us lol.

I'm going to write strictly from my point of view here, experienced but not professional !

Ok before we start lets just say getting #high is real easy and inexpensive if you have #Type1Diabetes, all it takes is nice healthy food that has #Carbohydrate in it. Without insulin this carbohydrate (of any kind) has the ability to make us real sick and even hospitalise us. 

The High, if left un-noticed & untreated is closely followed by Ketones, and then we're in big trouble. 

We basically have an intolerance to carbohydrate, we can't process it and move it on. All because our autoimmune system has gone into overdrive and has killed off the insulin producing islets in our pancreas, so anytime we eat carbohydrate we must inject insulin.

FYI the foods without those carbs are (fish, meat, eggs, cheese, diet or sugar free drinks & water) O Ye and lettuce. So called "Diabetic" foods are a NO GO ! They are expensive and more importantly they are a laxative that comes complete with tummy cramping and urgency (if you get my meaning) .........

When it comes to my "Highs" I don't know which part is worse.

• The absolutely awful taste in my mouth, that I call  "candy floss mouth".
• The dreadful headache, that paracetamol won't touch.
• The severe lack of focus my eyes have, like someone's changed the lens when I wasn't looking.
• Wet irritated eyes, that stream water.
• A runny nose.
• Feeling really unwell
• The cramps in my tummy and then of course the diarrhoea.
• That "I need space" I'm irritated feeling. 
• The backed into a corner feeling, that makes me want to come out fighting.

Luckily those who know me, don't fuss me, I just inject insulin, drink water, and then sleep, I normally set an alarm to check again an hour later to make sure my BG is coming down. If not ? Then more insulin.

No I'm not saying these are the actual symptoms of #Hyperglycemia. I'm saying that this is what happens to me. I would suffer from what I call "Dumping" anytime my system is not happy because of (high BG, some foods, some medications etc) my insides go into fight or flight mode and get rid of it real fast.

I find my Highs a little bit of a snake in the grass, it sort of slithers up on me with no warning and most times for no obvious reason. Unlike its pall on the other end of the #Type1 #SeeSaw, (the #Hypo) 

With a #Hypo, visibly seeming drunk and the fairly instant feeling that goes with it generally prevents an emergency, unless I sleep through the initial stages and wake very very low, but getting high is a bit different, and I could be very high before I realise it. Don't know about you but getting it down is a slow process. For all these reasons I went on a CGM to help with a more proactive way of managing my #Type1

I'm told if we did a breathalyser test when very high, we would fail it and it would show up as over the limit. Iv never tried it but I suppose it makes sense, that much glucose / sugar just 

Floating around in our blood.

The other really scary thing I discovered is, when blood sugar is high, the lens of the eye swells, even after getting your BG back to normal it can take weeks for the swelling to go down fully.

It was only as I began to struggle hearing, that I found out it effects the delicate hearing organs too.

High blood sugar effects every single part of our bodies,  doing damage to delicate nerves, organs, extremities, & skin all of which suffer when you have prolonged periods of blood glucose that is higher than recommended.

It's important to know that it's not just eating and then not injecting insulin for the food we'v eaten that causes us to get a high BG (Blood Glucose) 

Very often it's my high BG that lets me know I'm not well, or at least I'm not going to be well, but let me explain this.

Any kind of infection can rise my BG, before I know exactly what's wrong. 

I'd know a day or so before, Iv a kidney infection, a cold, ear ache, chest infection, etc as the onset of an illness / infection will be effecting my BG before I actually feel ill. These are thing it's best not to ignore. 

I suppose what I'm saying is. Be strict when it comes to managing your blood glucose. Get to know yourself very well, if you keep a physical record of your daily BG, you won't be long about knowing when something is not right.

I'm going to leave you with Some Diabetes Language you may find useful when trying to understand what people in the diabetes community are talking about, and yes Diabetes has a language 

• DSM ( diabetes self management )
• MDI ( Multiple Daily Injections ) 
• Pumping ( wearing an insulin pump )
• CGM ( continuous glucose meter )
• High ( Blood Sugar above the required limit )
• Hypo ( blood sugar below the required limit )
• Basel ( background insulin only )
• Bolus ( fast acting insulin we inject with food )
• Testing ( finger pricking to test blood glucose )
• BG ( blood glucose )
• Sensor ( is attached to the skin for use with a CGM )
• Site ( this is a term usually used by pumpers when using  an insulin pump) referring to the place on their body they put their "set" their insulin comes from their pump, through very fine tubing, attached to the set thats attached to their body.

• Correction ( this is the ratio for correcting a high BG)
• Hypo kit ( is GlucoGen injection for emergencies when unconscious, glucose tablets or drink, Jelly sweets, full sugar drink. Stuff we carry to treat a Hypo )

• Ratio ( every diabetic has a different ratio for their Bolus insulin, 

example : for every 5 grams carbs / 1 unit of insulin, a small plain scone without jam, might have 30gms carbs, this would need 6 units of insulin.  (30 gms carbs ➗ 5 insulin /carb  = 6 units of insulin needed)

Davina 

Type 1 Diabetes & The Golden Prick Award

Type 1 Diabetes & The Golden Prick award !

Living with type 1 or type 2 diabetes in isolation from others who live the same mathematical, clock watching, tightrope as we do, it's easy to just let things slip, and before you realise whats going on your sitting in your endo's office explaining how your HBA1C is so high, to someone with their head slightly tipped to one side and trying to wear their best sympathetic smile while nodding in acknowledgement of what we are saying, as they listen to the endless supply of lies we feed them. The chest infection we had, the steroids that our stupid GP prescribed, the dog eat my meter and I didn't have a spare ( yes Iv heard that one ), the flu shot made me as high as a kite ...... For weeks ! ( Iv used this one ). 

The truth is that sometimes we just get sick of it all. Sometimes when your the only one in a group of non diabetics it's hard to do what we're supposed to do. We all need to fit in, however,  constantly fitting in, will leave us "long term" in trouble because of the diabetes complications that lifestyle can lead to. 

Sitting with non type1 friends, and whipping out the meter, the strips, and the finger pricker as we proceed to do a blood test there and then, so we know what insulin is needed for the food we'r about to eat, can be met with gasps, awkward silences or disapproving looks. It's not like we can do it all under the table. It's a fiddley business.

For this very reason it's good to mix with others who have the same lifestyle as you, TOTAL understanding, comfort, support, information and help, all serve to make living with any type of diabetes just a bit more bearable.

There's not a week goes by without someone in one group or another, either totally excited with a HBA1C result, or in other cases totally floored by their result. No matter what the BG meter result says on the many occasions through the day that we test, it's the big exam that's all important and a decent result feels like recognition of a job well done. I seriously think a little trophy or reward should be standard at a diabetes clinic. 

I actually stood in my garden one day in spring, after cutting myself on a Rose thorn, to save myself from yet another finger prick I grabbed my meter and tested my BG. I hear you, I hear you, relax, hygiene etc, but at that moment i was going low, I saw an opportunity not to have to prick my finger and I took it.

Most people would wash it, disinfect it and plaster it, all I could think of was "free & effortless blood" all ready for use. In my world any blood is a potential test.

My well pricked fingers don't always donate and a good squeeze is sometimes necessary. One day there I was wearing very pale pink, all dressed up and ready to leave the house, one quick check I thought. What I got was a shower or blood that shot across the kitchen and all down my clothes.

So it's off with the dress, and out with the disinfectant to clean the floor, the counter top, the tiles and anything else that got it. Quick check ? Ye right ! The joys of well used fingers.....

Lick or wipe ? Are you kidding me ? Think of this. Your out, all dressed up and you need to check your BG because you don't feel right. 

Your low, now honestly do you fiddle around looking for tissue, getting blood on clothes ? 

Or do you lick and desperately search for something sugary before it's too late ? 

Remember when you answer the above questions "low & thought" rarely happens, unlike "low, instinct & automatic" when survival is all that matters.

That was life before my CGM so now it's testing every 12 hours to calibrate my medtronic guardian, finally my finger tips are beginning to feel a bit more like normal, and the alarm goes before I get to the brain dead stage.

For all that my poor fingers have been through Id like to win or at least be nominated for the "golden prick" award. 

Davina 

More than a Mum, A day in the life of Stacy and her child with Type 1 Diabetes

More than a Mum

These are  Stacey's feelings,

Stacy is Mum to a child with Type 1 Diabetes.

A Day in their Life.

T1D is a 24/7 job ... and everyday is like studying for the most important test in your life then the next day it all changes and all that you studied no longer matters because the questions on the test are no longer the same material that you studied for ...

It is gaining a medical degree in a matter of days and then being left to make life altering medical decisions constantly...

Its injecting medicine into your child that they need to save and keep life, but that very same medicine has the ability to, god forbid take there life in the blink of an eye ...

It is living in a constant fear that you cannot show to the outside world ...

It is dealing with ignorance on a daily basis and judgment from people who don't have a clue..

Its about trying to get people to understand just about everything has carbohydrate in it, so unless you want my child to survive on only water yes I have to test, measure and calculate everything IN FRONT of you ....

It is dealing with strange looks from people who do not understand and don't see why you may be watching and hovering over your child at any given time and why you cannot relax because you are trying to let them act like a regular kid but you know what the number on that little machine reads ..

its about truly never sleeping again....

its about holding your child while they sob because they don't wanna have diabetes anymore, they don't wanna be poked and prodded they don't wanna watch the other kids do whatever they want, they don't wanna sit out of the birthday cupcake that came to school, and watch everyone enjoy it while they eat a cheese stick cause their blood sugar is over 300 and no one ever bothered to let you know they would be celebrating a birthday that day...

Its about dealing with school issues and what occurs with your child after a low or a  high Blood Sugar and how it takes longer for their brain to clear and focus afterwards ....

As a parent it is about losing a small piece of yourself daily because you are giving every piece of yourself to your child and this disease, all while trying to function normally as a person and be there for the rest of your family ...

Its about constant worry, about all the other health issues and risks that go along with this disease that can also god forbid take their life ...

 its about learning who is truly there for you and who isn't ..

it is packing for a small trip everywhere you go making sure you have ALL your supplies and food for lows and food for highs and drinks for both....

 it is also about holding your head up high at the end of the day and saying to yourself I DID IT.

I tackled all these things again today and I kept my child healthy..

This is NOT a pity party it is a request to Please don't ever judge others.

You don't know what their daily struggles are.

Stacy......